IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0091891.html
   My bibliography  Save this article

Levonorgestrel-Releasing Intrauterine System vs. Usual Medical Treatment for Menorrhagia: An Economic Evaluation Alongside a Randomised Controlled Trial

Author

Listed:
  • Sabina Sanghera
  • Tracy Elizabeth Roberts
  • Pelham Barton
  • Emma Frew
  • Jane Daniels
  • Lee Middleton
  • Laura Gennard
  • Joe Kai
  • Janesh Kumar Gupta

Abstract

Objective: To undertake an economic evaluation alongside the largest randomised controlled trial comparing Levonorgestrel-releasing intrauterine device (‘LNG-IUS’) and usual medical treatment for women with menorrhagia in primary care; and compare the cost-effectiveness findings using two alternative measures of quality of life. Methods: 571 women with menorrhagia from 63 UK centres were randomised between February 2005 and July 2009. Women were randomised to having a LNG-IUS fitted, or usual medical treatment, after discussing with their general practitioner their contraceptive needs or desire to avoid hormonal treatment. The treatment was specified prior to randomisation. For the economic evaluation we developed a state transition (Markov) model with a 24 month follow-up. The model structure was informed by the trial women's pathway and clinical experts. The economic evaluation adopted a UK National Health Service perspective and was based on an outcome of incremental cost per Quality Adjusted Life Year (QALY) estimated using both EQ-5D and SF-6D. Results: Using EQ-5D, LNG-IUS was the most cost-effective treatment for menorrhagia. LNG-IUS costs £100 more than usual medical treatment but generated 0.07 more QALYs. The incremental cost-effectiveness ratio for LNG-IUS compared to usual medical treatment was £1600 per additional QALY. Using SF-6D, usual medical treatment was the most cost-effective treatment. Usual medical treatment was both less costly (£100) and generated 0.002 more QALYs. Conclusion: Impact on quality of life is the primary indicator of treatment success in menorrhagia. However, the most cost-effective treatment differs depending on the quality of life measure used to estimate the QALY. Under UK guidelines LNG-IUS would be the recommended treatment for menorrhagia. This study demonstrates that the appropriate valuation of outcomes in menorrhagia is crucial.

Suggested Citation

  • Sabina Sanghera & Tracy Elizabeth Roberts & Pelham Barton & Emma Frew & Jane Daniels & Lee Middleton & Laura Gennard & Joe Kai & Janesh Kumar Gupta, 2014. "Levonorgestrel-Releasing Intrauterine System vs. Usual Medical Treatment for Menorrhagia: An Economic Evaluation Alongside a Randomised Controlled Trial," PLOS ONE, Public Library of Science, vol. 9(3), pages 1-11, March.
    • Handle: RePEc:plo:pone00:0091891
    DOI: 10.1371/journal.pone.0091891
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0091891
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0091891&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0091891?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Brazier, John & Roberts, Jennifer & Deverill, Mark, 2002. "The estimation of a preference-based measure of health from the SF-36," Journal of Health Economics, Elsevier, vol. 21(2), pages 271-292, March.
    2. John Brazier & Jennifer Roberts & Aki Tsuchiya & Jan Busschbach, 2004. "A comparison of the EQ‐5D and SF‐6D across seven patient groups," Health Economics, John Wiley & Sons, Ltd., vol. 13(9), pages 873-884, September.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Brazier, JE & Yang, Y & Tsuchiya, A, 2008. "A review of studies mapping (or cross walking) from non-preference based measures of health to generic preference-based measures," MPRA Paper 29808, University Library of Munich, Germany.
    2. D. Stratmann‐Schoene & T. Kuehn & R. Kreienberg & R. Leidl, 2006. "A preference‐based index for the SF‐12," Health Economics, John Wiley & Sons, Ltd., vol. 15(6), pages 553-564, June.
    3. Stavros Petrou & Christine Hockley, 2005. "An investigation into the empirical validity of the EQ‐5D and SF‐6D based on hypothetical preferences in a general population," Health Economics, John Wiley & Sons, Ltd., vol. 14(11), pages 1169-1189, November.
    4. Garry Barton & Tracey Sach & Michael Doherty & Anthony Avery & Claire Jenkinson & Kenneth Muir, 2008. "An assessment of the discriminative ability of the EQ-5D index , SF-6D, and EQ VAS, using sociodemographic factors and clinical conditions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(3), pages 237-249, August.
    5. Bruno Casal & Eva Rodríguez-Míguez & Berta Rivera, 2020. "Measuring intangible cost-of-morbidity due to substance dependence: implications of using alternative preference-based instruments," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(7), pages 1039-1048, September.
    6. Richard Grieve & Marina Grishchenko & John Cairns, 2009. "SF-6D versus EQ-5D: reasons for differences in utility scores and impact on reported cost-utility," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(1), pages 15-23, February.
    7. Garry R. Barton & Tracey H. Sach & Anthony J. Avery & Claire Jenkinson & Michael Doherty & David K. Whynes & Kenneth R. Muir, 2008. "A comparison of the performance of the EQ‐5D and SF‐6D for individuals aged ≥ 45 years," Health Economics, John Wiley & Sons, Ltd., vol. 17(7), pages 815-832, July.
    8. Finch, Aureliano Paolo & Mulhern, Brendan, 2022. "Where do measures of health, social care and wellbeing fit within a wider measurement framework? Implications for the measurement of quality of life and the identification of bolt-ons," Social Science & Medicine, Elsevier, vol. 313(C).
    9. Yaling Yang & John Brazier & Louise Longworth, 2015. "EQ-5D in skin conditions: an assessment of validity and responsiveness," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(9), pages 927-939, December.
    10. Carmen Selva-Sevilla & Paula Ferrara & Manuel Gerónimo-Pardo, 2020. "Interchangeability of the EQ-5D and the SF-6D, and comparison of their psychometric properties in a spinal postoperative Spanish population," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 649-662, June.
    11. L. M. Lamers & C. A. M. Bouwmans & A. van Straten & M. C. H. Donker & L. Hakkaart, 2006. "Comparison of EQ‐5D and SF‐6D utilities in mental health patients," Health Economics, John Wiley & Sons, Ltd., vol. 15(11), pages 1229-1236, November.
    12. Rowen, D & Brazier, J & Roberts, J, 2008. "Mapping SF-36 onto the EQ-5D index: how reliable is the relationship?," MPRA Paper 29831, University Library of Munich, Germany.
    13. Richard Huan Xu & Dong Dong & Nan Luo & Eliza Lai-Yi Wong & Yushan Wu & Siyue Yu & Renchi Yang & Junshuai Liu & Huiqin Yuan & Shuyang Zhang, 2021. "Evaluating the psychometric properties of the EQ-5D-5L and SF-6D among patients with haemophilia," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(4), pages 547-557, June.
    14. Silvia Garrido & Ildefonso Méndez & José-María Abellán, 2013. "Analysing the Simultaneous Relationship Between Life Satisfaction and Health-Related Quality of Life," Journal of Happiness Studies, Springer, vol. 14(6), pages 1813-1838, December.
    15. Nick Kontodimopoulos & Evelina Pappa & Zinovia Chadjiapostolou & Eleni Arvanitaki & Angelos Papadopoulos & Dimitris Niakas, 2012. "Comparing the sensitivity of EQ-5D, SF-6D and 15D utilities to the specific effect of diabetic complications," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 111-120, February.
    16. Brazier, J, 2005. "Current state of the art in preference-based measures of health and avenues for further research," MPRA Paper 29762, University Library of Munich, Germany.
    17. Tsuchiya, Aki & Brazier, John & Roberts, Jennifer, 2006. "Comparison of valuation methods used to generate the EQ-5D and the SF-6D value sets," Journal of Health Economics, Elsevier, vol. 25(2), pages 334-346, March.
    18. Ayse Kuspinar & Nancy Mayo, 2014. "A Review of the Psychometric Properties of Generic Utility Measures in Multiple Sclerosis," PharmacoEconomics, Springer, vol. 32(8), pages 759-773, August.
    19. Rowen, D & Brazier, J & Tsuchiya, A & Hernández, M & Ibbotson, R, 2009. "The simultaneous valuation of states from multiple instruments using ranking and VAS data: methods and preliminary results," MPRA Paper 29841, University Library of Munich, Germany.
    20. David Feeny, 2012. "The Multi-attribute Utility Approach to Assessing Health-related Quality of Life," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 36, Edward Elgar Publishing.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0091891. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.